Methods: Ninety-one clusters of 60 people aged 50+ were selected randomly and a rapid assessment of avoidable blindness (RAAB) was conducted. Participants had their visual acuity and cause of visual impairment assessed, underwent a random glucose test and fundoscopy under mydriasis if they had diabetes. The diabetic retinopathy (DR) degree was classified according to the Scottish diabetic retinopathy grading scheme.
Results: From the sample 5,055 (92.6%) people were examined. The blindness prevalence was 1.7% (95% Confidence Interval: 1.3–2.1%). Cataract (32.6%), DR (29.1%) and glaucoma (16.3%) were the leading causes of blindness. The prevalence of severe, moderate, and early visual impairment was 1.0%, 5.1%, and 7.7%, respectively. Among respondents, 31% had diabetes and 8.1% of them was not diagnosed prior to the study. Of all participants with diabetes, 50% had glucose levels of 200 mg/dl or higher and 15.7% had sight-threatening diabetic retinopathy.
Conclusions: Besides strengthening of cataract intervention activities, more ophthalmic services for diabetic retinopathy and glaucoma control are needed in Nuevo León to provide timely intervention to prevent blindness. 相似文献
Methods: A cross-sectional population-based survey was performed on a representative sample of urban and rural individuals aged ≥50 years of the province. Blindness was defined as presenting visual acuity (PVA) <3/60 in the better eye. Moderate visual impairment (MVI) and severe visual impairment (SVI) were defined as 6/60 ≤ PVA <6/18 and 3/60 ≤ PVA <6/60 in the better eye, respectively. Diabetes mellitus (DM) was determined based on random blood sugar (RBS) levels ≥200 mg/dL or a previous diagnosis. We used the Scottish grading system to grade DR.
Results: We invited 2975 individuals from 85 clusters. Age- and sex-adjusted prevalence and 95% confidence interval (CI) of blindness, SVI, MVI, and DM in 2587 participants (response rate: 86.9%) were 1.5% (95% CI: 1.1–2.0), 1.5% (95% CI: 0.9–2.0), 11.3% (95% CI: 9.9–12.7) and 21.4% (95% CI: 19.2–23.7), respectively. The leading causes of blindness were cataract (47.1%), age-related macular degeneration (14.7%) and DR (8.8%). Cataract surgery (CS) coverage was 69.3%. The main challenges for CS were cost and unawareness. The outcome of CS was good in 66.9% of operated eyes. Any DR and/or maculopathy were observed in 25.3% (95% CI: 21.0–29.5) of subjects including 12.6% (95% CI: 9.7–15.6) sight-threatening DR. In previously known DM cases, 215 (41.7%) had never undergone an eye examination for DR.
Conclusion: The proportion of avoidable blindness and DR is considerable in Gilan Province. 相似文献
Methods: On December 1, 2016 we searched MEDLINE, EMBASE and Web of Science databases for cross-sectional blindness prevalence surveys undertaken in LMICs between 2000 and 2014. All surveys listed on the Rapid Assessment of Avoidable Blindness (RAAB) Repository website (“the Repository”) were also considered. For each survey we assessed (1) availability of scientific publication, survey report, summary results tables and/or datasets; (2) time to publication from year of survey completion and journal attributes; (3) extent of blindness information reported; and (4) rigour when information was available from two sources (i.e. whether it matched).
Results: Of the 279 included surveys (from 68 countries) 186 (67%) used RAAB methodology; 146 (52%) were published in a scientific journal, 57 (20%) were published in a journal and on the Repository, and 76 (27%) were on the Repository only (8% had tables; 19% had no information available beyond registration). Datasets were available for 50 RAABs (18% of included surveys). Time to publication ranged from <1 to 11 years (mean, standard deviation 2.8 ± 1.8 years). The extent of blindness information reported within studies varied (e.g. presenting and best-corrected, unilateral and bilateral); those with both a published report and Repository tables were most complete. For surveys published and with RAAB tables available, discrepancies were found in reporting of participant numbers (14% of studies) and blindness prevalence (15%).
Conclusion: Strategies are needed to improve the availability, consistency, and quality of information reported from blindness prevalence surveys, and hence reduce avoidable waste. 相似文献
Methods: The study was conducted between June and August 2015. All facilities in the country providing cataract services were contacted to obtain information on surgeries performed in 2014. Hospitals performing eye surgery in Quena, Sharkia, and Fayoum regions were visited and a questionnaire on resources for cataract surgery was completed.
Results: Cataract surgery was offered in the public sector by 64 government and 16 university teaching hospitals and in the private sector by 101 hospitals. Over 90% of all facilities in the country contacted participated in the study. In 2014, the national cataract surgical rate (CSR) was 3674 varying in governorates from 7579 in Ismailia to 402 in Suez. The private sector performed 70% of cataract surgeries.
Analysis of three regions showed an 11.7% increase in cataract output between 2010 and 2014. The average number of cataract surgeries per unit in 2014 was 2272 in private, 1633 in university, and 824 in government hospitals. Private hospitals had 60% of human resources for eye care. Phacoemulsification was the surgical technique in 85.6% of private, 72.1% of university, and 41% of government hospitals.
Reasons explaining the differences in output between public and private sectors were the lack of trainers, supervisors, and incentives.
Conclusion: The private sector provides most of the cataract services in Egypt, resulting in inadequate services for the poor. There is a 15-fold variation in CSR between the best and least served regions. The public sector could increase cataract output by improving training, supervision, and incentives. 相似文献
Methods: In a population-based cross-sectional survey of 5530 individuals aged 50 years or older from 10 villages selected by cluster sampling, individuals who had undergone cataract surgery in one or both eyes were identified. Consenting participants were administered a questionnaire, underwent vision assessment and ophthalmic examination. Outcomes were classified as good if visual acuity of the operated eye was 6/18 or better, fair if worse than 6/18 but better than or equal to 6/60, and poor if worse than 6/60.
Results: Prevalence of cataract surgery in this age group (771 persons) was 13.9% (95% confidence interval, CI, 13.0–14.9%). In the 1112 eyes of 749 persons studied, at presentation, 53.1% (95% CI 50.1–56.1%) of operated eyes had good, 38.1% (95% CI 35.2–41.0%) had fair, and 8.8% (95% CI 7.1–10.5%) had poor outcomes. With pinhole, 75.2% (95% CI 72.6–77.8%) had good, 17.2% (95% CI 14.9–19.5%) had fair, and 7.4% (95% CI 5.8–9.0%) had poor outcomes. In 76.3% of eyes with fair and poor presenting outcomes we detected an avoidable cause for the suboptimal visual acuity. Place of surgery and duration since surgery of 3 years or more were risk factors for blindness, while SES, sex and site of first eye care contact were not.
Conclusion: The high prevalence of avoidable causes of visual impairment in this rural setting indicates the scope for preventive strategies. 相似文献
Methods: A total of 51 clusters of 80 people (all ages) were sampled with probability proportionate to size and compact segment sampling. Visual acuity (VA) was measured with a tumbling “E” chart. An ophthalmic nurse examined people with VA<6/18 in either eye. The presence of hearing and physical impairments were assessed using clinical examination, and self-reported visual problems using the Washington Group Short Set.
Results: In total, 4080 people were enumerated of whom 3567 were screened (response rate 87%). The overall prevalence of visual impairment was 2.3% (95% CI 1.8–3.0%) and blindness was 0.6% (0.3–1.0%). The prevalence of both blindness and visual impairment increased rapidly with age, so that the vast majority of cases of visual impairment (84%) and blindness (82%) were in people aged 50+. Posterior segment disease and cataract were the main causes of blindness and visual impairment, with refractive error also an important cause of visual impairment. Cataract surgical coverage (proportion of all cataracts that had received surgery) was relatively high (87% of people at VA<6/60). Post-surgery outcomes were poor, with 31% of operated eyes having VA<6/60. Among the 82 people with visual impairment, 22% had a physical impairment or epilepsy and 30% had a hearing impairment. Self-reported difficulties in vision were relatively closely related to clinical measures of visual impairment.
Conclusions: Ophthalmic programmes in Cameroon need to incorporate control of posterior segment diseases while also working to improve outcomes after cataract surgery. 相似文献
Methods: A cross-sectional study using multistage random sampling from four cocoa growing districts in Ghana was conducted from November 2013 to April 2014. A total of 512 cocoa farmers aged 40 years and older were interviewed and examined. The brief interview questionnaire was administered to elicit information on the demographics and socioeconomic details of participants. The examination included assessment of visual acuity (VA), retinoscopy, subjective refraction, direct ophthalmoscopy, slit-lamp biomicroscopy and intraocular pressure (IOP). For quality assurance, a random sample of cocoa farmers were selected and re-examined independently.
Results: Moderate to severe visual impairment (VA <6/18 to 3/60 in the better-seeing eye) was present in 89 participants (17.4%) and 27 (5.3%) were blind (presenting VA <3/60 in the better eye) defined using presenting VA. The main causes of visual impairment were cataract (45, 38.8%), uncorrected refractive error (42, 36.2%), posterior segment disorders (15, 12.9%), and corneal opacity (11, 9.5%).
Conclusion: The prevalence of visual impairment and blindness among cocoa farmers in Ghana is relatively high. The major causes of visual impairment and blindness are largely preventable or treatable, indicating the need for early eye care service interventions. 相似文献
Methods: Standard RAAB reports were downloaded from the repository or requested from principal investigators. Potential predictor variables included prevalence of uncorrected refractive error (URE) as well as gross domestic product (GDP) per capita, health expenditure per capita of the country across World Bank regions. Univariate and multivariate linear regression were used to investigate the correlation between potential predictor variables and the ratio.
Results: The results of 94 surveys from 43 countries showed that the ratio ranged from 1.35 in Mozambique to 11.03 in India with a median value of 3.90 (Interquartile range 3.06;5.38). Univariate regression analysis showed that prevalence of URE (p = 0.04), logarithm of GDP per capita (p = 0.01) and logarithm of health expenditure per capita (p = 0.03) were significantly associated with the higher ratio. However, only prevalence of URE was found to be significant in multivariate regression analysis (p = 0.03).
Conclusion: There is a wide variation in the ratio of the prevalence of low vision to the prevalence of blindness. Eye care service utilization indicators such as the prevalence of URE may explain some of the variation across the regions. 相似文献
Methods: Fifty-one clusters of 80 people (all ages) were sampled with probability proportionate to size. Households within clusters were selected through the compact segment sampling. Visual acuity (VA) was measured with a tumbling “E” chart. An Ophthalmic Assistant or Vision Technician examined people with VA<6/12 in either eye. Other impairments (hearing, physical) were clinically assessed and self-reported functional difficulties measured using the Washington Group Extended Set. People with visual impairment and age-sex matched controls with normal vision were interviewed about poverty, employment and education.
Results: 4,125 people were enumerated and 3,574 screened (86.6%). The prevalence of visual impairment (VA<6/12) was 8.0% (95% CI = 6.9–9.4%) and blindness was 0.4% (0.2–0.9%), and both increased rapidly with age. Uncorrected refractive error was the leading cause of visual impairment, and cataract the leading cause of blindness. Cataract surgical coverage (proportion of all cataracts that had received surgery) was relatively low (41% of people at VA<6/60), while the post-surgery outcomes were good (81% of operated eyes had presenting VA≥6/18). Among the 287 people with visual impairment, 15% had a moderate/severe physical impairment or epilepsy and 25% had a moderate/severe hearing impairment. Self-reported difficulties in vision were relatively closely related to visual acuity. People with visual impairment were more likely to be in the poorest quartile (OR = 1.9, 95% CI = 1.0–3.4) or unemployed (5.0, 2.2–10.0), compared to controls.
Conclusions: Visual impairment was common in Mahabubnagar district, was mostly avoidable, and was correlated with poverty markers. 相似文献
Methods: In three rural villages served by Gusau eye clinic, key informants helped identify 80 adults with bilateral severe visual impairment or blindness (<6/60), with cataract being the cause in at least one eye. The median amount participants were willing to pay for cataract surgery was determined. The proportion willing to pay actual costs of the (i) subsidised surgical fee (US$18.5), (ii) average non-medical expenses (US$25.2), and (iii) average total expenses (US$51.2) at Gusau eye clinic were calculated. Where participants would seek funds for surgery was determined.
Results: Among 80 participants (38% women), most (n = 73, 91%) were willing to pay something, ranging from <US$1 to US$186 (median US$18.5, interquartile range 6.2–31.1). Approximately half of the participants (n = 41) were willing to pay US$18.5 (78% men), one-third (n = 26) were willing to pay US$25.2 (77% men); and 11% (n = 9) were willing to pay US$51.2 (all men). Only six participants (8%) already had the money to pay; one quarter (n = 20) would need to sell possessions to raise the funds.
Conclusion: Willingness to pay for cataract surgery among adults with operable cataract in rural Zamfara state is far lower than current costs of undergoing surgery. People who were widowed—most of whom were women—were willing to pay least. Further financial support is required for cataract surgery to be universally accessible. 相似文献
Methods: Study participants comprised 16,086 adults aged 40 years or older who had never been diagnosed with or undergone surgery for cataract using Korean National Health and Nutrition Examination Survey data from 2008 to 2012. Participants were assessed to have cataract when diagnosed with cortical, nuclear, anterior subcapsular, posterior subcapsular, or mixed cataract. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to evaluate the magnitude and significance of the association between serum 25(OH)D levels and cataract in multivariable logistic regression models.
Results: The OR for nuclear cataract with the highest quintile of serum 25(OH)D levels was 0.86 (95% CI 0.75–0.99) compared to the lowest quintile. A linear trend across quintiles was significant. Natural log-transformed serum 25(OH)D levels were also significantly associated with nuclear cataract (OR 0.84, 95% CI 0.75–0.95). The opulation-attributable fraction of nuclear cataract due to serum 25(OH)D insufficiency (<30 ng/mL) was 8.8% (p = 0.048).
Conclusions: Serum 25(OH)D levels were inversely associated with the risk of nuclear cataract. Prospective studies investigating the effects of serum 25(OH)D levels on the development of nuclear cataract are needed to confirm our findings. 相似文献
Methods: Using the resources of the Rochester Epidemiology Project, a retrospective population-based, case-control study was performed. Cases included 6024 county residents aged 50 years and older who had first-eye cataract surgery between 1 January 2004 and 31 December 2011. Controls included residents who had never had cataract surgery and were matched to cases by age, sex, and index date within 1 month of surgery. Statin medications continuously prescribed for at least 1 year before the surgery date (cases) or index date (controls) were examined. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression models.
Results: There were 2557 (42%) statin users among cases having cataract surgery compared to 2038 (34%) statin users among controls never having had cataract surgery (p < 0.0001). Incident cataract surgery was significantly associated with increased odds of statin use (OR 1.29, 95% CI 1.19–1.55) after adjusting for age, sex, diabetes, cardiovascular disease, cerebrovascular disease, peripheral vascular disease, renal disease, oral and inhaled steroid use, and selective serotonin reuptake inhibitor use. The association was consistent in both subgroups of women (OR 1.34, 95%CI 1.22–1.49) and men (OR 1.17, 95% CI 1.05–1.30).
Conclusions: Incident cataract surgery was associated with increased odds of statin use, and underscores the possibility that increasing statin use could be contributing to rising rates of cataract surgery. 相似文献
Methods: Population-based, cross-sectional study conducted in 9 cities located in the Midwest region of the state of São Paulo, Brazil, between 2006 and 2007, including 4690 individuals aged ≥30 years. Diabetes was self-reported and DR was assessed by indirect ophthalmoscopy.
Results: The prevalence of type 2 diabetes was 8.68% (95% confidence interval, CI, 7.87–9.48%), and DR was present in 7.62% (95% CI 5.02–10.20%) of participants with self-reported type 2 diabetes. Approximately 35.4% of individuals diagnosed with DR did not know they had diabetes prior to DR diagnosis. Prevalences of low vision and blindness were higher among those with diabetes and DR. Cataract was still a major cause of blindness in this population.
Conclusion: This is the first large population-based study on DR in Brazil. High rates of visual impairment were found in persons with type 2 diabetes, but cataract is still one of the main causes of blindness. Large surveys are necessary for public health policy advocacy in developing countries. 相似文献
Methods: Retrospective analysis of all uveitis cases visiting uveitis clinic of Bangladesh Eye Hospital between January, 2009 and April, 2015.
Results: In total, 652 patients (mean age 32.3 years, female 47.8%) were included in the study. Uveitis was bilateral in 42.6% of cases. Anterior uveitis was the most common (39.2%) case, closely followed by intermediate uveitis (22.2%), posterior uveitis (22%), and panuveitis (16.4%). Specific diagnosis was established in 53.3% of patients. The three most common specific diagnoses were ocular tuberculosis (10.7%), followed by HLA-B27-related uveitis (10.1%) and Vogt–Koyanagi–Harada disease (VKHD; 8.4%).
Conclusion: Ocular tuberculosis remained an important cause of uveitis in Bangladesh while HLA-B27 and VKHD were found to be the most common non-infectious uveitic entity. 相似文献
Methods: This is a cross-sectional study of 5070 participants from three large longitudinal epidemiologic studies of age-related eye disease, hearing, olfaction, and cognition. Slit-lamp photos of the lens were obtained to grade nuclear cataract using a standardized protocol. The quality of sleep was assessed using a modified Wisconsin Sleep Cohort Study questionnaire. Multiple linear regression analyses were used to assess the associations between levels of nuclear cataract/cataract extraction and the number of sleep problems. Systemic co-morbidity data were included as potential confounders, including diabetes mellitus, obesity, hypertension, cerebrovascular disease, thyroid disease, tobacco and alcohol use, and physical component summary score and mental component summary score.
Results: The mean age of the cohort was 57.6 years (range 22–95 years). The majority of the cohort demonstrated nuclear cataract levels 2 or 3 (36.8% and 30.1%, respectively). A total of 8% of the cohort had an intraocular lens (IOL) in at least one eye. There was no statistically significant correlation between sleep problems with presence of either nuclear cataract or IOL implant (p > 0.05).
Conclusion: In this cross-sectional, population-based study, we found no significant association between nuclear cataract or presence of IOL with poor sleep quality after adjusting for potential confounders. Studies of the longitudinal impact of nuclear cataract and cataract removal on sleep are needed to elucidate the role of nuclear cataract and cataract removal on sleep. 相似文献
Methods: In this cross-sectional study, four villages in Upper Egypt were randomly selected; within these four villages, households were randomly selected and within the selected households all residents aged ≥40 years were enumerated and enrolled. Door-to-door eye examinations of household members were conducted. Data on relevant demographic and socioeconomic characteristics were collected. The prevalence and causes of vision loss and associated risk factors were assessed. Sex differences in prevalence and determinants were also evaluated.
Results: The prevalence of best eye presenting visual impairment, severe visual impairment, and blindness were 23.9%, 6.4%, and 9.3% respectively. The prevalence of blindness among women significantly exceeded that among men (11.8% vs. 5.4%, respectively, p = 0.021). The prevalence of cataract was 22.9% (higher in women, 26.5% than men 17.2%, p = 0.018). The prevalence of trachomatous trichiasis was 9.7% (higher among women, 12.5%, than men, 5.4%, p = 0.012). The principal causes of blindness were cataract (60%), uncorrected refractive errors (16%) and corneal opacities (12%). Age, sex, family size, illiteracy, unemployment, water source and sanitation methods and living conditions were the major risk factors for vision loss.
Conclusion: The prevalence of visual impairment remains high in Egypt, particularly among women. Risk factors for blindness may differ between men and women. There is a need for qualitative investigations to better understand the causes behind the excess in prevalence of blindness among women. 相似文献
Methods: A population-based, cross-sectional survey of children was conducted in three phases in Pavagada and Madhugiri taluks (subdivisions) of Tumkur district in the state of Karnataka, India. In the first phase, trained fieldworkers screened 23,100 children. In the second phase, children with eye diseases were referred to the peripheral hospital to be examined by a general ophthalmologist. In the third phase, children with major eye diseases were examined by a pediatric ophthalmologist.
Results: The prevalence of ocular morbidity was 2.66% (95% confidence interval, CI, 2.46–2.87%). The most commonly observed ocular morbidity was Bitot spots (1%) followed by refractive error (0.6%). In total, 18 children were blind and the prevalence of childhood blindness (best-corrected visual acuity <3/60) was 0.08% (95% CI 0.04–0.11%); 8 (44.44%) had retinal blindness, 5 (27.76%) had lens-related blindness, 2 (11.11%) had bilateral microphthalmos, 1 (5.56%) was blind due to anterior staphyloma in the right eye and anophthalmos in the left eye, 1 (5.56%) had bilateral uveal coloboma and 1 (5.56%) had cortical visual impairment.
Conclusions: Nearly half of the blindness in the population was due to unavoidable causes (retinal). In addition to providing eye care services, an appropriate service delivery model would include the provision of rehabilitative and low vision services and implementation of genetic studies to understand the causes and increase awareness of inherited eye diseases. 相似文献
Methods: The number of patients in Scotland with APACG in each of the years between 1998 and 2012 was obtained from Information Service Division (ISD) Scotland. Data was also obtained for patients who had undergone laser PI and cataract surgery. The annual rates of APACG, PI and cataract surgery were calculated using Scotland’s population data during each of these years.
Results: Between 1998 and 2012 the rate of APACG in National Health Service patients decreased by 46.4% (from 46.7 to 25.0 per million, p < 0.005). The rate of PI increased overall by 116.3% (from 38.0 to 82.2 per million), but demonstrated a decrease of 48.2% (38.0 to 19.7 per million, p = 0.002) between 1998 and 2008, and an increase of 317.3% (19.7 to 82.2 per million, p = 0.005) between 2008 and 2012. Over the same 15-year period, cataract surgery increased by 73.4% (from 354.2 to 615.2 per 100,000, p < 0.005). In this timeframe, mid-year Scottish population estimates increased by 4.6%.
Conclusion: Our results demonstrate a significant reduction in the rate of APACG in the Scottish population between 1998 and 2012, along with a rising rate of PI and cataract surgery. The trend of decreasing APACG may be due to the increasing rate of cataract surgery in the same time period. This parallels patterns seen in other European countries. We discuss these findings together with other related epidemiological factors. 相似文献